MEDICARE: ACCESS ANESTHESIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	052014	TX

General Provider Information

NPI Number	:	1578649570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ANESTHESIA

Provider Business Mailing Address
First Line	:	3863 SW LOOP 820
Second Line	:	SUITE 300
City	:	FORT WORTH
State	:	TX
Zip	:	76113
Country	:	US
Telephone Number	:	817-294-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5744 LYNDON B JOHNSON FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6322
Country	:	US
Telephone Number	:	972-490-4333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAY TYDLASKA
Credential	:
Telephone Number	:	817-294-7444

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/22/2020

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